Name of Manual - Blue Cross and Blue Shield of Minnesota

Two Physicians
Involved in Care/
Same Tax ID
Coding Policies and Guidelines (Maternity)
There are situations where the primary physician provides prenatal
and postnatal care but does not deliver the baby. The most
common situation noted is when a surgeon from the same medical
group as the primary physician delivers the baby via C-section.
Many times the primary physician is also acting as an assistant-atsurgery.
In the case where both physicians are in the same practice
(same tax ID), Blue Cross is recommending the following
submission guides:
Same tax-ID – clinic provider number reported for the claim
Surgeon – bills the global C-section (59510); individual
provider number or NPI of the surgeon reported on the service
line
Primary physician – bills the C-section assist (59514-80);
individual provider number or NPI of the physician reported on
the service line
Provider production and disbursement of reimbursement is an
internal process. It is the clinic’s responsibility to assure the
providers participating in the patient’s care are appropriately paid.
Newborn Care Submit procedure code 99460 or 99462 and diagnosis code V20.1
to bill for routine services in the hospital for well newborns. If the
newborn is ill, submit codes 99221-99223 or 99231--99233 for
hospital visits. Initial hospital care of neonates, 28 days of age or
less, who require intensive observation, frequent interventions, and
other intensive care services is reported with code 99477.
Subsequent intensive care for very low birth weight infants is
reported with codes 99478-99480, depending on the weight of the
infant. For discharge day management, submit 99238. Pediatric
standby should be submitted with code 99464. Standby services
are requested by another physician. The physician may not be
providing care or services to other patients during this period.
Standby, 99464, includes the initial stabilization of the newborn,
thus services may be denied as incidental to 99464. When billing a
newborn circumcision (54150 or 54160) on the day of discharge,
add modifier –25 to code 99238. A diagnosis indicating the
circumcision (V50.2) must be linked as the primary diagnosis to
the circumcision procedure (54150 or 54160).
For neonatal critical care services see codes 99468-99476.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/20/12)
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